The Price of Perky Boobs

“Look at my boobs and tell me what you think.”

I’m a 20-year-old retail assistant, beseeching an older colleague and close friend, to evaluate my bare breasts in the backroom after hours. Unbuckling my bra, I stand before her, totally exposed. “What are you talking about?” She responds. “They’re fine!” After years of self-critiquing, I wasn’t convinced.

While the perceived ‘perfect’ size of breasts have fluctuated with time, breasts have always been beholden to one immovable standard: perky. Those with breasts that align with this archetype may consider their boobs a source of #freethenipple empowerment. Other women feel a kind of wearied distaste for their tatas; forgoing a bra is inconceivable, and god forbid they go on top. Some have embraced a kind of ‘it-is-what-it-is’ booby ambivalence.

I spent several college summers fitting bras at a contemporary lingerie chain—measuring breasts, buckling brassieres and at times, literally lifting flesh into cups—so I have met all these women. I have been them, too. When the pandemic found me in my mid-20s – prompting a massive lifestyle shift and a discovery of disordered eating. I’d moved to the west coast and, without daily walking around New York City, took up running and downloaded Noom, a calorie counter app that promptly capped my daily intake at 1200 calories. (Editor’s note: Research has shown that calorie tracking, including with apps, may contribute to eating disorders.) Within three months, my breasts descended four bra sizes, taking my nipples with them. With that, my boobs entered their new, deflated era, and for the first time, I felt incentivized to confront the issue.

I was not the only one to recently research breast lifts—the number of people searching for them peaked during summer 2021, and has continued to spike each summer since, according to Google Trends. It’s coincided with the arrival of Ozempic, forcing women—and myself—into the same societally-constructed conundrum. Weight loss? We like it. Small, saggy breasts caused by weight loss? Unacceptable. From 2019 to 2023, the American Society of Plastic Surgeons says there was a 30 percent increase in requests for breast lifts (mastopexies)—placing the procedure in direct competition with its more popular sister: implants. “I want my titties pinned back to my shoulders, right where they used to be,” Rihanna revealed in last month’s issue of Interview. “I don’t want implants. I just want a lift.”

We're forced into a societally-constructed conundrum. Weight loss? We like it. Small, saggy breasts caused by weight loss? Unacceptable.

New York-based board-certified plastic surgeon Norman Rowe has made his name on the Upper East Side and beyond as a breast expert. In the past year, his requests for lifts have almost tripled—an exponential increase that he says is a result of rampant semaglutide use."

“I get a lot of women who've lost a substantial amount of weight, especially with Ozempic,” he says. “The more weight someone loses—and the quicker they lose it—the more impact that has on the skin. Body procedures are just going through the roof, 30 percent of our business is now dedicated to face, breast and back lifts.”

When I first consulted with Dr. Rowe for a breast lift, he sketched the anchor-like incision required. He would cut around the areola, down the center of the breast, removing excess skin and raising the nipple so it no longer faces down. This would not create cleavage or add fullness. For that, he emphasized, you need an implant.

“A lift will take care of the sag in the skin, it will take care of the position of the nipple, but it will not address the volume loss of the upper poles of cleavage,” he says. (“Upper poles” is how plastic surgeons refer to the breast tissue above the nipple.) Patients often come in without realizing the limitation of a breast lift, says Dr. Rowe. “There is a misconception among patients of what a lift is. So I figured out the way to ask if they wanted an augmentation or a lift was, ‘Do you want cleavage?’ Either you want to get bigger and your cleavage to change, or you want to be the same size but get rid of the droopiness.”

I fit into the latter group, or so I thought. Anyone who remembers the 90s will also remember that buxom beauties were not only abundant but considered femininity made manifest. Even if you joined in on the bimbo jokes that shamed the cosmetically enhanced likes of Pamela Anderson and Carmen Electra, their perfectly rounded, perky breasts were still taped to the bedroom walls of your school crush. Anything less than a squeeze-worthy palmful, anything that succumbed to gravity, would be passed over by Playboy editors—relegated instead to the readership of National Geographic.

In the weeks leading up to my surgery, I would debate the pros and cons of implants over and over again. Like Dr. Rowe, I was struggling to understand my expectations. Due to their generally higher placement, my nipples would be raised only an inch. With the removal of skin, my 34D boobs would likely decrease by a half or a whole cup size. Was it worth going through all of this, just for slightly smaller tits with slightly higher nipples? Would I be satisfied with, well, a slight difference?

This was also plaguing Dr. Rowe, who responded to my initial consultation with multiple surgical plans. “One of the key things that I try to ascertain when I'm examining a patient: what are their true expectations and, more importantly, are they realistic for the patient?”

Was it worth going through all of this, just for slightly smaller tits with slightly higher nipples? Would I be satisfied?

When Dr. Rowe first opened his private practice in 2004, he was routinely implanting 500 and 600cc implants—for reference, one cup size is around 250cc. With larger implants dropping faster, creating sagging, he says women have trended smaller in the last five years. Fat transfer enhancements, popular among those seeking natural-looking breasts, can calcify into hard lumps and be mistaken for cancer during mammography—resulting in additional surgery. The complications and shelf lives associated with implants have also become more well-known: follow-up implant removal or replacement surgeries after 10 years or sooner, and ruptured implants need to be replaced in up to 17.7% percent of patients after 6 or 10 years (the rupture rate after revision augmentation is between 2.9% and 14.7%). Breast implant illness is a controversial topic—it’s a term patients came up with, rather than a medical diagnosis; there’s a lack of data on the topic; and no real agreement about what the symptoms are, though patients tend to name hard-to-track ones, like fatigue, joint pain, brain fog, rash, memory loss—but the FDA and many doctors agree there’s still much to learn, Grant Stevens, the president of the American Society for Aesthetic Plastic Surgery (ASAPS) and a clinical professor of plastic surgery at the Keck School of Medicine of USC, previously told to Allure.

Still, the promise of built-in cleavage was tempting. I wanted to go braless without insecurity. Wear plunging dresses without experimenting with endless sticky cutlets. I didn’t want to tug up my breasts in tight tops. At the same time, I didn’t want to go bigger, and I didn’t want to possibly undergo multiple surgeries on my breasts as I aged. My heart just wasn’t in the implants.

“Whereas I used to do a lot of breast implant mastopexies—where you put in the implants at the same time—today, I'm probably doing a larger number of mastopexies [breast lifts] alone,” he says.

Post-consultation, the options Dr. Rowe offered me were a mastopexy with a small implant or a mastopexy with an internal bra. The internal bra is a lesser-known procedure that originated in the ‘80s, reaching wider awareness more recently, Rowe says, with the help of a rebrand and big marketing push. Originally, the internal bra was a kind of cone shape (picture Madonna) created from a Gore-tex mesh. Over time, there were claims the mesh may have been obscuring mammography, and insurance companies began rejecting claims for mammograms if the patient had an internal bra. That’s where Galaflex came in. A new internal bra material first implemented around 2016, it’s best described as an absorbable mesh sewn into the chest wall.

“Think of it as a hammock,” says Dr. Rowe. “It goes underneath the implant [around existing breast tissue] and keeps it from descending over time. You don't need a full cone because you’re not pulling anything up—but you are protecting the implant from moving down after two years. You have your own sling.”

A lot of breast surgeries rely on skin to hold up an implant or (in the case of a lift-only) breast tissue, Dr. Rowe explained to me, but skin is not capable of bearing weight. Someone who has skin that has been stretched from rapid weight loss is a perfect candidate for an internal bra because that stretching of the skin weakens the layer of collagen that’s usually a built-in structure to prevent descent. But after Galaflex dissolves, in about 1-2 years, “it gets replaced by collagen — which would not have been there otherwise,” says Dr. Rowe, an assessment validated by studies published in the journals Aesthetic Surgery (in 2022 and 2016) and Plastic and Aesthetic Research. “While the internal bra itself is gone, its impact remains.”

This was enough to convince me to get an internal bra, which starts at $10,000 at Dr. Rowe's practice, making the cost of a breast lift with an internal bra $40,000 and up. While I was assured the results of an internal bra are not permanent—Dr. Rowe said I could expect them to last for at least 10 years—it does make it less likely for the breasts to droop over time. And an internal bra is less likely to interfere with breastfeeding—something that may or may not be in my future—than an implant.

My surgery took around an hour and a half. I was in the clinic by 7:30am, put under general anesthesia, and awake around 11:30am. During the procedure, Dr. Rowe removed excess skin and sewed the gauze to my ribcage, reshaping the remaining skin and tissue to lift my breasts and nipples while reducing the size of my areolas. I was back to my hotel room in a surgical bra by noon. Recovery requires you to wear a surgical bra, day and night, for at least a month — eventually downgrading to a sports bra until around six weeks. A surgical bra is a wireless bralette that closes at the front (so you don’t have to stretch your arms back), and feels very lightweight but also extremely tight. The compression helps with the swelling but also keeps the breasts in their proper place as they heal. I was unable to sleep on my side for around 10 days, and there’s no lifting more than 10 pounds, or working out other than walking, for three weeks. Following that, scar tape or gel on the sutured areas (around the areola, down and under the breast) is an everyday essential for a year.

This dress was impossible for me to wear without a bra before, now they sit perfectly without any support.
This dress was impossible for me to wear without a bra before, now they sit perfectly without any support.

The first several days require heavy reliance on another person. For the first 48 hours, my boyfriend lifted and lowered me into bed, dressed me, and brushed my hair and teeth because I couldn’t raise my arms. I was encouraged to walk the next day, and allowed to fly or drive if necessary on the second (I’d traveled to New York City for the surgery, and had booked my flight back home two days later). I had full mobility again by day three or four, but the discomfort should also not be underestimated—specifically with the internal bra. I felt a constant pang and tugging pain on my ribcage that affected even the most basic activities (like lifting groceries or shaving my legs) for the first several weeks.

For the first 24 hours, I was in so much pain that I cried all the way through my post-op appointment the next morning. In the first 24 hours, I was taking a low-dose prescription opiate by itself, which wasn’t enough pain medication, so Dr. Rowe recommended I take it in conjunction with Extra Strength Tylenol. (He compared Tylenol to the main meal, while Oxycodone and Tramadol were a kind of ‘chaser’—supplementing the OTC medication should I need something stronger.) Through my tears, I revealed my new, bruised breasts to Dr. Rowe. Upon inspecting his work, the surgeon concluded he was “very happy” with the results.

“You're trying to make their soul better,” he explains of cosmetic surgery. “While I'm not taking out their appendix, when a patient sees themselves as having a flaw–rightfully so or not–you're trying to correct it. And sometimes to them, it's life and death. Honestly, down deep, I'm a fixer. Seeing a problem and getting a solution, a good solution, it's gratifying.”

I didn’t look at my breasts for the first week—a mostly unconscious choice. For as long as I remember, I have avoided looking at my breasts entirely. Even before my weight loss changed their appearance significantly I always felt unsatisfied with them on a bad day, or ambivalent at best. Eight days after surgery, I unzipped my surgical bra and inspected the result for the first time. Dr. Rowe had reduced the size of my areolas, raised the nipples, and rounded my breasts into two symmetrical mounds. The anchor-shaped incision was sutured with almost invisible stitches. I was looking at boobs I had only seen on screen, or on my most genetically-blessed friends.

I turn away from the mirror. The change might seem slight to some, but to me, mastopexy had made a world of difference. “Tell me what you think,” I say to my boyfriend. “They’re perfect,” he responds. This time, I believed the beholder.

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Originally Appeared on Allure